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General NPI Number Information
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NPI Number | 1881939106
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Entity Type | Individual
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Provider Name | MILES DUSTIN SUMNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 3332 WALDEN AVE STE 110
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City | DEPEW
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State | NY
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Zip | 14043-2400
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Country | US
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Telephone | 716-668-7051
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Fax | 716-668-7069
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Provider Business Mailing Address
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Address Line | 3761 COLIN CT
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-3601
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Country | US
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Telephone | 716-491-9426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 016411-1
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License Number State | NY
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